To determine how venoarterial extracorporeal membrane oxygenation (ECMO) affects cerebral blood flow velocity (CBFV) measured by transcranial doppler (TCD), to determine whether specific changes in cerebral blood flow velocity may be associated with neurologic injury and to determine modifications of CBFV after withdrawal of ECMO.
Venoarterial Extracorporeal membrane oxygenation (ECMO) is used in adult with refractory cardiac failure as a life-saving measure. Adults treated with ECMO survived to hospital discharge in 21,8% to 65,4% of cases. Neurologic complications such as intracranial hemorrhage, anoxia and ischemia are major causes of death and long-term disability in ECMO patients (7% to 14%). Current neurological monitoring techniques are insufficient to predict which critically ill patient receiving ECMO therapy will suffer from neurologic injury. Even after a clinical suspicion of neurologic injury, diagnosis can be difficult. TCD is commonly used to monitor the CBFV of traumatic brain injury. There are no reports that evaluate CBFV of patients requiring ECMO therapy. Patient will have to do both echocardiography and TCD to evaluate cardiac output and CBFV. We will repeat these dopplers every 24 hours until ECMO withdrawal and one day after explantation.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
PREVENTION
Masking
NONE
Enrollment
30
Examination that involves the completion of a TCD and an TTE (Trans-Thoracic Echocardiography) : * To reports clinical parameters at the time of the examination : ECG data: sinus rhythm, atrial or ventricular arrhythmia, state of consciousness, heart rate, O2 saturation * To review of pharmacological parameters at the time of the examination : presence of sedation; presence, type and dose of catecholamines. * To collect biological data from the day of the examination : Partial Pressure of O2, PaCO2 (partial pressure) and hematocrit * To collect possible additional examinations : brain scan, EEG. These are non-invasive exams that do not require patient displacement. Only the samples taken by the medical team as part of the treatment will be analyzed.
University Hospital Toulouse
Toulouse, France
RECRUITINGCerebral blood flow velocities evolution
Cerebral blood flow velocities evolution over the time
Time frame: 24 hours
The correlation of Cerebral blood flow velocities with the variation of the cardiac output and ECMO flow.
The correlation with the variation of the cardiac output and ECMO flow.
Time frame: 24 hours
Relation between acute neurologic injury and variation of CBFV
Relation between acute neurologic injury and variation of CBFV detected by TCD.
Time frame: 24 hours
Modification of the CBFV detected by TCD after the withdrawal of the ECMO.
Modification of the cerebral blood flow velocity (CBFV) detected by TCD after the withdrawal of the ECMO.
Time frame: 24 hours
Relation between the CBFV, the NIRS, the cardiac flow and the ECMO flow.
Relation between the CBFV (cerebral blood flow velocity), the Near Infrared Spectroscopy (NIRS), the cardiac flow and the ECMO flow.
Time frame: 24 hours
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